Provider Demographics
NPI:1588829840
Name:BARSALONA-CANNISI, LYNNE ALLISON (LAC)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:ALLISON
Last Name:BARSALONA-CANNISI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 FORD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1726
Mailing Address - Country:US
Mailing Address - Phone:917-731-1513
Mailing Address - Fax:
Practice Address - Street 1:2830 FORD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1726
Practice Address - Country:US
Practice Address - Phone:917-731-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001827171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist